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Dupuy EG, Vincent T, Lecchino C, Boisvert A, Trépanier L, Nadeau S, de Guise E, Bherer L. Prefrontal engagement predicts the effect of museum visit on psychological well-being: an fNIRS exploration. Front Psychiatry 2024; 15:1263351. [PMID: 38501080 PMCID: PMC10944881 DOI: 10.3389/fpsyt.2024.1263351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024] Open
Abstract
Recent research suggests that museum visits can benefit psychological well-being by reducing symptoms of stress and anxiety. However, these reported relaxing effects remain inconsistent between studies. Shedding light on the underlying cerebral mechanisms of museum visits might support a better understanding of how it affects psychological well-being. This study aimed to investigate the prefrontal engagement evoked by artwork analysis during a museum visit and to determine if these prefrontal substrates are associated with the museum's effect on psychological well-being in older adults. Nineteen adults aged between 65 and 79, toured a Baroque-style exhibit at the Montreal Museum of Fine Arts for approximately 20 minutes while equipped with a near-infrared spectroscopy system measuring the prefrontal cortex's hemodynamic activity. For each painting, participants received the instruction to either (1): analyze the painting and produce a personal interpretation of its signification (analytic condition) or (2) visualize the painting without any specific thoughts (visualization condition). Questionnaires measuring stress, anxiety, and well-being were administered before and after the visit. Sixteen older women (71.5 ± 4 years) were included in the analyses. Results showed that, at the group level, the analytic condition was associated with an increased activation pattern in the left ventrolateral prefrontal region, typically related to attentional processes (not observed in the visualization condition). The activation associated with the analytic condition predicted pre-/post-visit reductions in self-reported anxiety and stress in the sample of older women. These observations suggest that the level of engagement of attentional processes during artwork analysis may play a major role in the effect of a museum's visit on self-reported symptoms of anxiety.
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Affiliation(s)
- Emma Gabrielle Dupuy
- Centre EPIC et centre de Recherche, Montreal Heart Insitute, Montreal, QC, Canada
- Département de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Thomas Vincent
- Centre EPIC et centre de Recherche, Montreal Heart Insitute, Montreal, QC, Canada
| | - Catia Lecchino
- Centre EPIC et centre de Recherche, Montreal Heart Insitute, Montreal, QC, Canada
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Annabelle Boisvert
- Centre EPIC et centre de Recherche, Montreal Heart Insitute, Montreal, QC, Canada
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Laurence Trépanier
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
- CRIR—IURDPM, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Sylvie Nadeau
- CRIR—IURDPM, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Elaine de Guise
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
- CRIR—IURDPM, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Louis Bherer
- Centre EPIC et centre de Recherche, Montreal Heart Insitute, Montreal, QC, Canada
- Département de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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2
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Sirisena M, Cheetham M. "You're sort of building community in a bigger way": exploring the potential of creative, nature-based activities to facilitate community connections. Arts Health 2024:1-16. [PMID: 38402628 DOI: 10.1080/17533015.2024.2319666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND This paper explores the opportunities that creative, nature-based activities offer for mobilising social connections via community-centred approaches to improve individual and collective wellbeing. METHODS The study involved ethnographic methods and data was gathered from a nature for wellbeing project implemented in a rural village in North East England. RESULTS The findings indicate creative, nature-based activities delivered within an environment marked by an ethic of care and kindness enabled the project to engage with participants at individual and collective levels simultaneously, which enhanced the project's ability to mobilise community skills and assets, and affect connectedness, equity and control within social groups facing significant disadvantages. CONCLUSION Creative, nature-based activities, delivered with an ethic of care, present an opportunity to recognise and engage complex and, at times, opposing undercurrents inherent in social connections between individuals and social groups.
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Affiliation(s)
- Mihirini Sirisena
- Population Health Science Institute, Newcastle University, Newcastle, UK
| | - Mandy Cheetham
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle, UK
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3
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Ma SHX, Tan MKB, Goh SSN, Yeo G, Teng A, Yang Y, Galéry K, Beauchet O, Ho AHY. A qualitative examination on the implementation of participatory "A"rt-based activity on "Health" of older community-dwellers: what worked for the Singapore A-Health Intervention? Front Med (Lausanne) 2023; 10:1238563. [PMID: 38179279 PMCID: PMC10766355 DOI: 10.3389/fmed.2023.1238563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Art and museum-based interventions are gaining increasing recognition for their potential as low-risk activities for older adults, offering numerous physical, cognitive, and emotional benefits. However, there remains a dearth of knowledge regarding the science of implementation as well as the factors and processes that contribute to their effectiveness from the perspectives of intervention participants. Methods The current research draws on the qualitative evaluation data obtained from a larger mixed-method randomized control trial that evaluated a standardized Participatory "A"rt-Based Activity On "Health" of Older Community-Dwellers-the Singapore A-Health Intervention. Adopting a participatory action research approach, the primary objective is to critically examine the lived experiences and health impact of the Singapore A-Health Intervention with a secondary objective to uncover strategies for optimized implementation outcomes. All 56 participants who completed the intervention filled out a program evaluation survey and a nested sample of 30 participants completed a series of acceptability focus groups. Results Descriptive analyses of the program evaluation survey data revealed that 96.2% of participants were satisfied with the overall experience of the Singapore A-Health intervention (M = 9.00, SD = 1.76), reported that the intervention positively impacted their quality of life (M = 8.90, SD = 1.43), and social wellbeing (M = 8.92, SD = 1.43). Thematic analysis with a grounded theory approach on the qualitative focus group data revealed three interrelated themes detailing how the Singapore A-Health Intervention contributed to positive health and wellbeing outcomes (1. A-Health Experience, 2. Wellbeing Outcomes, 3. Enabling Factors) and nine subthemes (1a. Intellectual Stimulation, 1b. Positive Stress, 1c. Peer Interaction, 2a. Interpersonal Bonds, 2b. Personal Growth, 2c. Mindful Living, 3a. Integrated Support, 3b. Session Design, 3c. Mode of Engagement). Discussion This investigation provides important insights to the Singapore A-Health intervention's effectiveness for enhancing wellbeing among older adults, as well as the factors that enable successful program implementation. These findings offer a culturally unique perspective on the benefits of art and museum interventions, while underscoring the imperative need for strong partnership and collaborations among community stakeholders in supporting the health and wellbeing of ageing populations.
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Affiliation(s)
- Stephanie Hilary Xinyi Ma
- Action Research for Community Health (ARCH) Laboratory, Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Michael Koon Boon Tan
- Lab4Living, Culture and Creativity Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Shannon Shuet Ning Goh
- Action Research for Community Health (ARCH) Laboratory, Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Gabriellia Yeo
- Action Research for Community Health (ARCH) Laboratory, Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Alicia Teng
- National Gallery Singapore, Community and Access, Singapore, Singapore
| | - Yilin Yang
- National Gallery Singapore, Community and Access, Singapore, Singapore
| | - Kévin Galéry
- Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada
| | - Olivier Beauchet
- Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada
- Departments of Medicine and Geriatrics, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Andy Hau Yan Ho
- Action Research for Community Health (ARCH) Laboratory, Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
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4
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Lee D, Masoodian M. Theoretical Models of Collaborative Partnerships in Arts-Health Care Practices for Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6888. [PMID: 37835159 PMCID: PMC10572975 DOI: 10.3390/ijerph20196888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
Although research investigating collaborative partnerships with older adults has been slow to develop, promoting user involvement and co-production is gaining interest in aging studies, with the aim of improving interactions between the different stakeholders involved, and toward the more effective delivery of care provisions and better community life for aging people. This is based on existing evidence that improved dynamics within collaborative and mutual learning processes can enhance the integration of new practices at different levels by generating novel creative approaches and practice frameworks for the delivery of quality care for older adults. This article presents the findings from a series of narrative interviews conducted with different stakeholders involved in arts-health practices in Finland and South Korea. Focusing on empirical perspectives of these stakeholders on arts-health practices-from planning to assessment-this study identifies vital components of co-producing and co-delivering arts-health practices for older adults and highlights the importance of utilizing their late-life creativity as active partners in such practices across cultural contexts. In addition to identifying three central stages of developing arts-health practices, two theocratical models are proposed to provide structural support for collaborative partnerships in arts-health practices, with the aim of promoting holistic care provisions for aging people through such practices.
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Affiliation(s)
- Dohee Lee
- School of Arts, Design and Architecture, Aalto University, 02150 Espoo, Finland;
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Warran K, Burton A, Fancourt D. What are the active ingredients of 'arts in health' activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework. Wellcome Open Res 2022; 7:10. [PMID: 35600003 PMCID: PMC9106992 DOI: 10.12688/wellcomeopenres.17414.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/03/2023] Open
Abstract
Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants working in arts in health, we engaged in a three-phase process: 1) scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of project, people, and contexts. Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation. Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may interconnect or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and articulation of what an arts in health activity entails.
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Affiliation(s)
- Katey Warran
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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6
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Warran K, Burton A, Fancourt D. What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework. Wellcome Open Res 2022; 7:10. [PMID: 35600003 PMCID: PMC9106992 DOI: 10.12688/wellcomeopenres.17414.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/02/2023] Open
Abstract
Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants working in arts in health, we engaged in a three-phase process: 1) scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of
project, people, and
contexts.
Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The
people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation.
Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may interconnect or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and articulation of what an arts in health activity entails.
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Affiliation(s)
- Katey Warran
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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7
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Pesata V, Colverson A, Sonke J, Morgan-Daniel J, Schaefer N, Sams K, Carrion FME, Hanson S. Engaging the Arts for Wellbeing in the United States of America: A Scoping Review. Front Psychol 2022; 12:791773. [PMID: 35222154 PMCID: PMC8863598 DOI: 10.3389/fpsyg.2021.791773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
There is increasing interest today in how the arts contribute to individual and community wellbeing. This scoping review identified and examined ways in which the arts have been used to address wellbeing in communities in the United States. The review examined 44 publications, with combined study populations representing a total of 5,080 research participants, including marginalized populations. It identified the types of artistic practices and interventions being conducted, research methods, and outcomes measured. It highlights positive associations found across a broad spectrum of psychological, physical, and social outcomes, including improvements in self-esteem and identity formation, cognition, physical balance, and physical conditioning. It also reports negative outcomes of arts interventions that may be underreported. The study identifies the need for core outcomes sets and reporting guidelines for advancing evidence synthesis in this area.
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Affiliation(s)
- Virginia Pesata
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Aaron Colverson
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Jill Sonke
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Jane Morgan-Daniel
- Health Science Center Libraries, University of Florida, Gainesville, FL, United States
| | - Nancy Schaefer
- Health Science Center Libraries, University of Florida, Gainesville, FL, United States
| | - Kelley Sams
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Flor Maria-Enid Carrion
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Sarah Hanson
- UF Department of Surgery, University of Florida, Gainesville, FL, United States
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Gabriel R. Affect, Belief, and the Arts. Front Psychol 2021; 12:757234. [PMID: 34925160 PMCID: PMC8674731 DOI: 10.3389/fpsyg.2021.757234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
The cultural project is a therapeutic melding of emotion, symbols, and knowledge. In this paper, I describe how spiritual emotions engendered through encounters in imaginative culture enable fixation of metaphysical beliefs. Evolved affective systems are domesticated through the social practices of imaginative culture so as to adapt people to live in culturally defined cooperative groups. Conditioning, as well as tertiary-level cognitive capacities such as symbols and language are enlisted to bond groups through the imaginative formats of myth and participatory ritual. These cultural materializations can be shared by communities both synchronically and diachronically in works of art. Art is thus a form of self-knowledge that equips us with a motivated understanding of ourselves in the world. In the sacred state produced through the arts and in religious acts, the sense of meaning becomes noetically distinct because affect infuses the experience of immanence, and one's memory of it, with salience. The quality imbued thereby makes humans attentive to subtle signs and broad “truths.” Saturated by emotions and the experience of alterity in the immanent encounter of imaginative culture, information made salient in the sacred experience can become the basis for belief fixation. Using examples drawn from mimetic arts and arts of immanence, I put forward a theory about how sensible affective knowledge is mediated through affective systems, direct perception, and the imagination.
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Affiliation(s)
- Rami Gabriel
- Research Group in Mind, Science, and Culture, Department of History, Humanities, and Social Sciences, Columbia College Chicago, Chicago, IL, United States
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9
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Lee JB, McIlfatrick S, Fitzpatrick L. Examining the Range and Scope of Artists' Professional Practices With Individuals With Palliative Care Needs: An International, Cross-Sectional Online Survey. Front Psychol 2021; 12:773451. [PMID: 34955991 PMCID: PMC8696005 DOI: 10.3389/fpsyg.2021.773451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Internationally, it is recognized that artists facilitate arts engagement with individuals with palliative care needs. There is a gap in the literature describing the range and scope of artists' professional practices in palliative care. The aim of this study was to examine an international range of professional practices among artists who work in palliative care including key professionals' perceptions of these practices. Methods: An international, cross-sectional, online survey was conducted with health professionals, artists, and program coordinators with experience with artists working in palliative care. This survey was part of a larger mixed methods study. An instrument was systematically developed to examine artists' professional practices. Descriptive statistics were reported for the total sample including frequencies, means and standard deviations and open-ended items were analyzed thematically. Results: 101 valid surveys were analyzed. Findings outlined: (1) who delivers the arts; (2) where and with whom; (3) practice descriptors; and (4) perceptions of practice. Themes identified from open-ended items on benefits and risks of practice revealed impacts on patients and artists alike, including: (1) enhanced well-being; (2) vulnerabilities; and (3) facilitators and barriers. Conclusion: Findings demonstrated a wide range of artists' practices in palliative and end-of-life care, featuring notable consistencies in international practice worth further exploration. Ongoing and international efforts examining artists' practices in palliative care contribute to the development of future research, policy and practice.
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Affiliation(s)
- Jenny Baxley Lee
- Institute of Nursing and Health Sciences Research, Ulster University, Coleraine, Northern Ireland
- Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville, FL, United States
- School of Arts and Humanities, Ulster University, Coleraine, Northern Ireland
| | - Sonja McIlfatrick
- Institute of Nursing and Health Sciences Research, Ulster University, Coleraine, Northern Ireland
| | - Lisa Fitzpatrick
- School of Arts and Humanities, Ulster University, Coleraine, Northern Ireland
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Tan MKB, Tan CM, Tan SG, Yoong J, Gibbons B. Connecting the Dots: The State of Arts and Health in Singapore. Arts Health 2021; 15:119-134. [PMID: 34846987 DOI: 10.1080/17533015.2021.2005643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: This article examines the state of the field of arts and health in Singapore and identifies the drivers that have shaped its development to date, adding new insights from Asia to the growing international literature in this area. Methods: Various methods, including an online survey and in-depth focus groups were used. Results: We find that the field in Singapore is rapidly growing, with a proliferation of activities across the arts and culture, healthcare, and social care sectors in recent decades fostered by various policy developments, increased funding and new peer-to-peer networking. Nevertheless, several issues persist, including inconsistent understanding and conceptualisation of the field as a whole across multiple stakeholders, limited research capacity and training platforms, and lack of professional recognition. Conclusions: We provide recommendations for further action, including developing arts and health literacy and research capacity, investing in efforts to bridge education and practice, and focusing on formalising and elevating professional standards.
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Affiliation(s)
| | - Chao Min Tan
- School of Art, Design and Media, Nanyang Technological University, Singapore
| | - Soon Guan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Joanne Yoong
- University of Southern California, Los Angeles, United States
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